Optimizing safety and accuracy of prostate biopsy

Jones, Tonye A.; Radtke, Jan Phillip; Hadaschik, Boris; Marks, Leonard S.

doi:10.1097/mou.0000000000000310

Cited by 15 publications

(11 citation statements)

References 60 publications

(126 reference statements)

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“…While there is ongoing debate regarding improved detection of clinically significant prostate cancer (csPCa) with targeted biopsies preferred to cognitive techniques, not all csPCa will be diagnosed [4]. Some tumours are not visible on MRI [6], and mpMRI can underestimate tumour volume, leading to incomplete lesion sampling with targeted biopsies [7] and biopsy inaccuracy [8]. Padhani et al [6] highlight the need to validate tissue sampling based on mpMRI Prostate Imaging Reporting and Data System (PI-RADS) findings; however, a specific methodology has not been defined.…”

Section: Introductionmentioning

confidence: 99%

Use of a trizonal schema to assess targeting accuracy in prostatic fusion biopsy

Franklin

Gianduzzo²,

Yaxley

et al. 2020

BJU International

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Objectives To describe the use of a novel 'trizonal' biopsy schema in which 'near‐target' biopsies are taken adjacent to the MRI lesion, in addition to target and systematic biopsies, to determine the accuracy of prostate MRI fusion systems. Participants and Methods A trizonal biopsy technique was used to evaluate 75 men with small Prostate Imaging Reporting and Data System (PI‐RADS) 3–5 MRI lesions (<15 mm) identified from a prospective cohort of 290 men undergoing multiparametric magnetic resonance imaging (MRI) for suspected prostate cancer at a single high‐volume institution between September 2017 and May 2019. In addition to target and systematic biopsies, near‐target biopsies were taken 4 mm from the apparent border of the MRI lesion. Comparisons were made between highest International Society of Urological Pathology grade and longest tumour length. Results Fifty‐three men with significant prostate cancer in the same quadrant as the target were included in the final analysis. The percentages of positive cores from target, near‐target and MRI‐negative zones were 66%, 39% and 17%, respectively. Significant cancer was detected in the near‐target zone in 77% of cases when the target zone was positive. A total of 17% of participants were upgraded by a median (range) of 1 (1–3) grades through the addition of near‐target cores. Notably, 9% of men were diagnosed with clinically significant prostate cancer solely via the near‐target biopsy cores when the target cores were negative. Conclusion The use of near‐target biopsies as part of a trizonal biopsy schema provides a novel methodology to optimize clinically significant prostate cancer detection.

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Section: Introductionmentioning

confidence: 99%

Use of a trizonal schema to assess targeting accuracy in prostatic fusion biopsy

Franklin

Gianduzzo²,

Yaxley

et al. 2020

BJU International

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“…The National Comprehensive Cancer Network (NCCN), European Association of Urology (EAU), and European Society of Urogenital Radiology (ESUR) guidelines recommend MRI for patients with elevated PSA or a negative result in a previous biopsy with a PSA which persists and rises. MRI, and mpMRI in particular, reduces overdetection and overtreatment of clinically insignificant PCa and facilitates early detection of significant cancer 5) . Multiparametric MRI consists of T2WI, DWI, dynamic contrast enhanced imaging (DCE), and/or magnetic resonance spectroscopic imaging (MRSI).…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of PCa is expected to increase worldwide, with the growing aging population and widespread screening programs for this disease. Since the 1980s, TRUS-guided biopsy has been the standard method for obtaining tissue for histological diagnosis, but its limitations are increasingly being recognized 1)-4) , including imprecise sampling and frequent diagnosis of clinically insignificant PCa 5) .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Diagnosis with Non-contrast Magnetic Resonance Imaging/Transrectal Ultrasound Fusion-Guided Transperineal Prostate Biopsy

Takahata

Horie

2020

Juntendo Medical Journal

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We evaluated the efficacy of non-contrast magnetic resonance imaging (MRI)/transrectal ultrasound (TRUS) fusionguided transperineal biopsy for the detection of prostatic carcinoma. Methods: Between November 2013 and June 2015, eighty-three men, who presented to the Department of Urology with a clinically suspicious prostatic cancer, underwent non-contrast MRI/TRUS fusion biopsy (FB) (BioJet ® : D&K Technologies, Kanalweg, Germany) and 16-core systematic biopsy (SB). All biopsies were taken through a transperineal template. In 27 patients, the Gleason scores of biopsy specimens were compared to those of radical prostatectomy specimens. Results: The median patient age was 69 years (IQR 67-73) and the median Prostate Specific Antigen (PSA) level was 6.6 ng/ ml (IQR 5.2-8.9). Fifty-three patients were diagnosed with prostate cancer (PCa) (64%) by biopsy. The per-core cancer detection rate (CDR) was found to be higher for FB than for SB (32.5 vs 13.3%; p < 0.0001). Although not statistically significant, the CDR for clinically significant PCa was numerically higher for FB than for SB (65.1 vs 58.0%; p = 0.309). The Gleason scores of prostatectomy specimens were assessed to be higher than those of biopsy specimens in 44% of the cases in the FB group and in 37% of those in the SB group. Conclusion: Our study adds to the literature which supports the potential role of non-contrast MRI/TRUS fusion-guided transperineal biopsy in the detection of PCa, with a significantly higher per-core CDR compared with SB.

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“…This decision was made based on the UCLA antibiogram and had prevented post-biopsy septic episodes over the last 1500 transrectal biopsies. 23 Given this success, we elected to also use it for transrectal laser ablation.…”

Section: Patient Preparationmentioning

confidence: 99%

Focal Laser Ablation of Prostate Cancer: An Office Procedure

Brisbane

Natarajan

Priester

et al. 2021

JoVE

Self Cite

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In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually similar to a fusion biopsy and is performed under local anesthesia in a clinic setting; treatment time is usually less than one hour. Laser insertion is guided by ultrasound; lesion targeting is via magnetic resonance imaging-ultrasound (MRI/US) fusion, as in targeted prostate biopsy. Real-time ablation monitoring is achieved utilizing a thermal probe adjacent to the laser fiber. The video demonstrates procedure planning, patient preparation, various steps during the procedure, and treatment monitoring. Safety, feasibility, and efficacy of this approach have been established during a previous trial. Outpatient FLA under local anesthesia is an option for management of intermediate risk prostate cancer. IntroductionProstate cancer (PCa) is the most common internal malignancy in U.S. men 1 . Approximately 190,000 new cases and 33,000 deaths are expected during 2020, making it the second most common cause of cancer death in men 2 . Most cases of PCa are curable if treated while localized to the prostate. However, identifying cancer within the prostate is often not possible with conventional ultrasound (US) imaging; thus, treatment has traditionally involved surgery or radiation of the whole gland. The 'whole-gland' paradigm has been altered with the introduction of magnetic resonance imaging (MRI), which, in contrast to US, enables localization of PCa and targeted biopsy 3 , 4 , 5 , 6 . While MRI likely underestimates the multifocality of PCa 7 , and may miss small lesions 8 , it can reliably identify the index lesion, which is almost always the driver of metastatic disease 9 , 10 .Reliable MRI identification of index lesions has provided a path for focal treatment of PCa (i.e., partial gland ablation (PGA)). The aim of PGA is to destroy the index lesion while preserving the organ and thus minimizing side effects. Focal laser ablation (FLA), which employs light energy to destroy

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Optimizing safety and accuracy of prostate biopsy

Cited by 15 publications

References 60 publications

Use of a trizonal schema to assess targeting accuracy in prostatic fusion biopsy

Use of a trizonal schema to assess targeting accuracy in prostatic fusion biopsy

Accuracy of Diagnosis with Non-contrast Magnetic Resonance Imaging/Transrectal Ultrasound Fusion-Guided Transperineal Prostate Biopsy

Focal Laser Ablation of Prostate Cancer: An Office Procedure

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